Claims for International Long Term Care Coverage

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jun 19, 2018

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The provisions in the sample long term care insurance policy clearly state the specific conditions under which benefits will not be paid. Most policies contain provisions similar to those outlined below.

If You are making a claim for Benefits under the International Coverage section of this Policy, any reference above to either charges You incur for Covered Servicesor to claim forms does not apply.

COMMENT: The one unique requirement that you must satisfy to be eligible for payment of Benefits for International Coverage is that you must be outside the United States and its territories. All other eligibility requirements for payment of Benefits are the same as when you are in the United States or its territories.

The above provision states that, as pertains to International Coverage, references to “charges you incur for Covered Services” or to “claim forms” may be disregarded because they don’t apply. The reason is that Benefits for International Coverage are paid in a different way. Benefits for International Coverage are paid on simple per diem basis. The Per Diem Benefit is not related to charges you incur. All you need to do is to show that you are eligible for payment of Benefits for International Coverage and you will be paid a pre-determined daily benefit amount. The Amount is 50% of the Home Care and Community Care Maximum Daily Benefit Amount shown on the Schedule of Benefits page of the Policy.

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